Surviving an injury — particularly one that resulted from a violent action — can cause significant emotional and mental-health challenges, including depression, anxiety, and post-traumatic stress disorder (PTSD). For marginalized communities, the risk factors for violence and injury are disproportionately higher: According to the National Survey of Children's Exposure to Violence, more than 60 percent of African-American youth in the United States are victims of crime, and almost 40 percent witness violence during their childhood. New research shows that exposure to violence and injury can affect more than just the individual's psyche; it causes them to become distant from important support networks, and can change the way they interact with and confide in those close to them.

The study, published in Injury, shows a significant number of African-American men in the United States who experience acute intentional injury withdrew from their families and peers, loosening support networks necessary to withstand the emotional effects that accompany physical injury.

The study surveyed 74 African-American men, all of whom were over the age of 18 and lived in the greater Philadelphia metropolitan area. The researchers interviewed the men in their own homes for three months after their discharge from the hospital. Men were excluded from the study if they had a diagnosis of PTSD, depression, or an active psychotic disorder at the time of the injury.

Understanding the disparities in emotional response can help in the formation of medical response, emotional treatment, and lasting support, especially for those in under-resourced communities, explains the study's co-author, Therese Richmond, the associate dean for research and innovation at the University of Pennsylvania School of Nursing.

The study "aimed to illuminate the impact of injury on [participants'] lives and their emotional health, in their own words," Richmond says. "You're a product of your life journey. That's all going to affect how any individual is going to respond to an acute traumatic injury. You're bringing that whole life experience with you."

Through a systematic analysis, the researchers broke down each interview to evaluate and identify different emotional themes, such as feeling on guard, depression, worry, avoidance, and anger. The study showed that 62 percent of the men talked about instances involving themes of life-threatening injury and chronic exposure to violence. The study emphasized one quote from a participant that illustrated growing distrust and changes in outlook:

Everything has changed for me. My entire life. From the way I walk. You know, sleep. ... It's, like, the way I think, I view the world, the way I think. My thought process towards people. Trust issues. Like a lot of psychological issues ... my trust issues for people in general has led to fear for strangers and people I don't know. Even people I do know or once trusted. I distance myself.

Emotional responses are quite universal, Richmond says, whether it's intentional or unintentional. For Richmond, the study confirmed that African-American men are experiencing significant emotional responses, which she says "are not really being adequately addressed from a health perspective."

"It's important to save lives, but we really need to up the game in assessing and providing psychological support for people who have traumatic injury," she says. "My goal is that you should optimally recover, but we don't put in the same emphasis or resources." The resources are limited for responding to the traumatic aftermath of injuries, and families often are not prepared or do not know how to anticipate these emotional responses.

It becomes difficult for many of these men to focus on recovery once they're discharged from the hospital. For many participants in the study, a large concern was being able to go back to work and "just being able to do what I need to do, physically." The push back into daily life, often with little support and possibly having to face their assailants, happens quickly: This leads to uncertainty in mental-health outcomes.

Richmond suggests initial changes can come on an individual and community level, using different language to start discussing these emotional responses. "We say to people when they have emotional responses, 'What's wrong with you?'" Richmond says. "By saying 'What's wrong with you?' we are saying something really is wrong with you. But saying 'What happened to you?' opens up a door."